Prevention of Cholangitis by Spontaneously Dislodging Biliary Stent After an Endoscopic Procedure in Patients With Asymptomatic Bile Duct Stones

Abstract

Objective

To evaluate the effectiveness of spontaneously dislodging biliary stent (SDBS) placement in preventing acute cholangitis after endoscopic retrograde cholangiopancreatography (ERCP) in patients with asymptomatic bile duct stones.

Methods

This retrospective, single-center study included 63 patients (mean age, 73 ± 11 years; 43 men) who underwent ERCP for asymptomatic bile duct stones at our institute between April 2022 and May 2024; they were categorized into the SDBS (33 patients) and non-stent (30 patients) groups. Stone removal was performed in all cases, and complete stone clearance was achieved. Post-procedure cholangitis was diagnosed based on the Tokyo Guidelines 2018. The primary endpoint was post-procedural acute cholangitis on day one. Secondary endpoints included cholangitis-related factors, type of device used, procedure time, and adverse events other than cholangitis. Multivariate analysis was performed to identify factors associated with post-procedure cholangitis.

Results

No significant differences were observed in prior cholecystectomy, bile duct diameter, or the number of stones between the two groups. The overall incidence of post-procedure cholangitis was 17.4%. The incidence was significantly lower in the SDBS group than in the non-stent group (6% vs. 30%; p = 0.01). No significant differences were observed in procedure time, incidence of complications such as post-ERCP pancreatitis, or postoperative hospital stay between the SDBS and non-stent groups. Multivariate analysis identified the absence of an SDBS (odds ratio, 6.09; 95% confidence interval, 1.04–35.6, p = 0.04) as an independent factor associated with post-procedure cholangitis.

Conclusion

SDBS placement may be effective in preventing cholangitis after ERCP in asymptomatic patients with bile duct stones.